- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04265066
Microcirculation in Prehospital Medicine (MicroCircPreHo)
February 10, 2020 updated by: Klinik für Kardiologie, Pneumologie und Angiologie
Prehospital Analysis of the Sublingual Microvascular Terminal Circuit in Emergency Patients - a Prospective Observational Study
Diagnostic and risk stratification are limited in emergencies.
The measurement of microcirculation might identify patients with poor perfusion but compensated macrocirculation such as in beginning shock.
This proof-of-concept study will examine whether sublingual prehospital sidestream dark field microscopy is feasible.
This prospective observational study will include patients receiving medical aid by an emergency ambulance who had a spontaneous circulation and offer access to the sublingual mucosa.
Sublingual measurement of microcirculation will be performed using a sidestream dark field camera.
Video-quality will be evaluated with MIQS (microcirculation image quality score).
AVA 4.3C software will calculate microcirculatory parameters.
Study Overview
Detailed Description
Risk stratification is a key element in emergency medicine and there is great interest to identify and validate novel tools and parameters.
These tools must be are easy to handle even in the emergency setting by emergency physicians and paramedics.
The main challenge for these tools is to identify critically ill patients, but usually, an ambulance disposes on clinical examination and basic hemodynamic values.
Therefore, diagnostic tools are limited to the assessment of macrocirculatory values, which are not very reliable and might not necessarily reflect factual organ perfusion.
Focusing only on macrocirculation might mask already ongoing impaired organ perfusion as tissue hypoxia is crucial and microcirculatory collapse or at least dysregulation occurs very early.
Reduced microcirculation might result in attenuated cellular nutrient and oxygen supply that might result in severe cell damage.
In fact, impaired microcirculation is ubiquitous in shock and can be found even in the setting of hemodynamic compensation.
An impaired microcirculation is often the very first sign of alarm for deteriorating critically ill patients.
A promising way to identify patients with impaired microcirculation is the use of sublingual IDF- and SDF-measurement (IDF: incident dark-field; SDF: sidestream dark field) devices as sublingual microcirculation is a suitable target because it reliably reflects organ perfusion.
Measuring sublingual microcirculation has already been used to identify high-risk patients in many intra-hospital or experimental settings.
These measurement tools are easy to use hand-held devices.
The newest generation of SDF offers the great improvement of automatic software which independently calculates various microcirculatory parameters.
Therefore, there is no need for the treating physician to interpret the videos by himself.
This investigation will take place in the ambulance emergency service of the metropolitan area around Düsseldorf, Germany.
To participate in the study, patients must meet the following criteria: 1) the call for an acute emergency outside the hospital with the indication for sending out an emergency doctor, 2) a spontaneous circulation without previous resuscitation, 3) informed consent, 4) the sublingual mucosa must be accessible.
The following data will be collected: age, sex, cause for emergency alarm (cardiac reason, respiratory reason, gastroenterological, oncological, general internal medicine, renal, neurological, psychiatric, paediatric, traumatic), and the National Advisory Committee on Aeronautics' (NACA), that ranges from 0 = no injury, 7 = lethal injury severity score.
Vital parameters (heart rate, non-invasive blood pressure, peripheral oxygen saturation) will be measured using a standard out-of-hospital monitoring device (Corpuls3 (GS Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany)).
Mean arterial pressure (MAP) will be calculated as follows: (2 * diastolic pressure + systolic pressure) /3.
The capillary refill was evaluated in a standardized manner as described by Hernandez et al.
Only sufficiently trained investigators will perform measurements.
The microcirculation will be assessed by the implementation of the sidestream darkfield microscope (MicroScan® device, Microvision Medical, Amsterdam, The Netherlands).
At the tip of the device, a highly sensitive camera digitally records the sublingual capillary network.
The software analysis can directly be performed and visualized on a tablet screen.
Additionally, the videos will be saved for later analysis.
A suitable tablet computer will be used (Microsoft Surface Pro 4, (Redmond, Washington, USA).
After acquisition of the videos, a validated automatic algorithm-software (AVA, Version 4.3 C) will perform the analyses.
According to the second consensus on the assessment of sublingual microcirculation in critically ill patients (European Society of Intensive Care Medicine), the following parameters of microcirculation will be assessed both for all and for small vessels: PPV (Percentage of Perfused Vessels), NC (Number of Crossings), PNC (Perfused Number of crossings), TVD (Total Vessel Density), PVD (Perfused Vessel Density).
The study plans to include at least 25 patients.
Study Type
Observational
Enrollment (Actual)
25
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
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Duesseldorf, Germany, 40225
- Division of Cardiology, Pulmonary Disease and Vascular Medicine
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
N/A
Genders Eligible for Study
All
Sampling Method
Non-Probability Sample
Study Population
Patients who call for an acute emergency outside the hospital
Description
Inclusion Criteria:
- the call for an acute emergency outside the hospital with the indication for sending out an emergency doctor
- a spontaneous circulation without previous resuscitation
- informed consent
- the sublingual mucosa must be accessible
Exclusion Criteria:
- <18 years
- Lacking informed consent
- time-critical disease
- previous resuscitation
- inaccessibility of sublingual area
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Observational Models: Case-Only
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Measurement of sublingual microcirculation
|
measurement of microcirculation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Microcirculatory quality score (MIQS)
Time Frame: at Baseline
|
MIQS by Massey et al. is an established method to validate recorded SDF-videos for their suitability for further analysis.
MIQS assigns a score of optimal (0 points), suboptimal but acceptable (1 point), or unacceptable (10 points) to the categories illumination, duration, focus, content, stability, and pressure.
The scoring will be done for every recorded video during the offline analysis.
|
at Baseline
|
Percentage of Perfusion Vessels [%]
Time Frame: at Baseline
|
Measurement of sublingual microcirculation by using MicroScan® microscope.
AVA 4.3C calculates automatically important microcirculatory values (Percentage of Perfusion Vessels; DeBackerDensity; Perfused DeBackerDensity; Perfused Vessel Density) according to the Second Consensus Conference
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at Baseline
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
NACA-scores
Time Frame: at Baseline
|
The National Advisory Committee on Aeronautics' (NACA) score ranges from 0 = no injury, 7 = lethal injury severity score and is an established method to estimate the severity of disease of emergency patients.
|
at Baseline
|
measurement of Blood pressure
Time Frame: at Baseline
|
Non-invasive blood-measurement will be done immediately for every emergency patient.
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at Baseline
|
measurement of Pulse rate [/per Minute]
Time Frame: at Baseline
|
Non-invasive pulse rate-measurement will be done immediately for every emergency patient using a pulsoxymeter.
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at Baseline
|
measurement of Peripheral oxygen saturation [%]
Time Frame: at Baseline
|
Non-invasive oxygen saturation measurement will be done immediately for every emergency patient using a pulsoxymeter.
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at Baseline
|
measurement of Respiratory rate [/Minute]
Time Frame: at Baseline
|
Respiratory rate will be assessed visually for every emergency patient
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at Baseline
|
measurement of microcirculation
Time Frame: at Baseline
|
Measurement of sublingual microcirculation by using MicroScan® microscope
|
at Baseline
|
Intra-Hospital Mortality
Time Frame: up to 1 year
|
Intra-Hospital mortality will be assessed using the medical records of the hospital or direct contact to the patient.
|
up to 1 year
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 1, 2018
Primary Completion (Actual)
September 1, 2019
Study Completion (Actual)
December 1, 2019
Study Registration Dates
First Submitted
January 29, 2020
First Submitted That Met QC Criteria
February 10, 2020
First Posted (Actual)
February 11, 2020
Study Record Updates
Last Update Posted (Actual)
February 11, 2020
Last Update Submitted That Met QC Criteria
February 10, 2020
Last Verified
February 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 16-031
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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